NPI | 1255578860 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: SC 0311) |
Additional Taxonomies | 208D00000X General Practice (Licence: GA 44513) |
Enumeration Date | 2009-01-20 |
Last Update Date | 2025-03-25 |